Factors associated with elevated serum alanine aminotransferase in patients with type 1 diabetes mellitus.

AIM: Metabolic syndrome and type 2 diabetes are associated with insulin resistance and hepatic steatosis, which are common causes of alanine aminotransferase (ALT) elevation. This study aims to identify variables associated with altered ALT in type 1 diabetic (DM1) subjects. METHODS: A cross-sectional study conducted in the outpatient endocrinology clinic of a university hospital. Patients with DM1 were seen between December 2012 and September 2013; clinical variables were collected from medical records. RESULTS: Fifty-six patients were included aged 27 ± 10.1 years; 60.7% were men. The study subjects exhibited an average ALT of 36.7 ± 10.3 U/L (median = 35 U/L) and their average Body Mass Index (BMI) was 23.8 ± 3.8 kg/m2. When comparing individuals with elevated ALT > 35 U/L (N. = 27) with those ALT ≤ 35 U/L (N. = 29), we found that individuals with ALT values > 35 U/L showed a higher proportion of men (77.8% vs. 44.8%, P = 0.012) and a higher mean age (30.2 ± 12.3 vs. 24.6 ± 6.9 years, P = 0.046). When new ALT reference values were applied (19 U/L for women and 30 U/L for men), five individuals had normal ALT values. Individuals with elevated ALT had higher BMI (24.3 vs. 20.9; P = 0.036), fasting glucose (194.8 ± 101.2 vs. 123.6 ± 42.0 mg/dL; P = 0.013) and higher HbA1c (9.9 ± 2.8 vs. 7.8 ± 0.7%; P < 0.001) levels. In Pearson correlation analysis, ALT values ​correlated with HbA1c (r = 0.285; P = 0.033). CONCLUSION: In patients with DM1, elevated ALT values ​​are associated with BMI, fasting glucose and HbA1c.

Longitudinal surveillance for meningitis by Acinetobacter in a large urban setting in Brazil.

The study aim was to describe the emergence of carbapenem resistance and clonal complexes (CC), defined by multilocus sequence typing (MLST), in Acinetobacter baumannii in a surveillance system for meningitis. Starting in 1996 in an urban setting of Brazil, surveillance detected meningitis by Acinetobacter sp for the first time in 2002. Up to 2008, 35 isolates were saved. Carbapenem resistance emerged in 2006, reaching 70% of A. baumannii isolates in 2008, including one that was colistin resistant. A. baumannii belonged to CC113/79 (University of Oxford/Institute Pasteur schemes), CC235/162 and CC103/15. Dissemination of infections resistant to all antimicrobial agents may occur in the future.

Nutritional assessment associated with length of inpatients' hospital stay.

OBJECTIVE: To evaluate the nutritional status of patients on hospital admission, identify the length of hospital stay and identify the parameters of nutritional assessment that are most closely related with the length of stay (LOS). METHODS: A cross-sectional study of 278 hospitalized patients evaluated patients' nutritional status in the 48 hours after admission and their LOS after discharge. Anthropometric and biochemical parameters, related to nutrition status were analyzed, such as: weight, height, arm circumference (AC), waist circumference (WC), triceps skinfold thickness (TST), mild arm muscle circumference (MAMC), albumin (Alb) and hemoglobin (HB). Body mass index (BMI) was used to classify the nutritional status. All the nutritional factors except type of disease, gender and age were associated with LOS. The chi-square, Student-t, Mann-Whitney, Kruskal-Wallis and binary logistic multivariate tests were used in the statistical analyses. RESULTS: The majority of patients was male (53%), elderly (56%) and had neoplasm (19.4%). Undernutrition was higher in the elderly (p < 0.05) and neoplasm patients (p < 0.05), overweight or obese patients were more likely to suffer from cardiovascular diseases (p = 0.001). Average LOS was 14.7 days (± 12.5), longer in neoplasm patients (p < 0.05) and in elderly ones (p < 0.05), and also was 3 times longer in males (p < 0.0001). Among the nutritional parameters, patients with AC under 25 cm had higher LOS (p < 0.05), but only in women could it be considered a marker, increasing LOS 2.8 times. BMI less than 20 kg/m(2) increased LOS 2.1 times, and biochemical data (Alb and HB) do not contribute. In the multivariate analyses, male gender and TST depletion were the significant factors, which together best explained the lengths of hospital stay. CONCLUSION: LOS was associated with disease, gender, age and nutritional status. We can highlight two anthropometric analyses: first, AC can be used in women as a marker of longer LOS and second TST is the best overall predictor of longer hospital stay.